PATIENT CASE Patient’s Chief Complaints and History of Prese

PATIENT CASE Patient’s Chief Complaints and History of Present…  PATIENT CASE Patient’s Chief Complaints and History of Present Illness  M.L. is a 50-year-old white female who has been working in the front office of a medical clinic for the past five years. She has made an appointment to see her primary care provider because she has been feeling very tired for the past month and has also been suffering from stiffness, pain, and swelling in multiple joints. “I ache all over,” she told her PCP, “and I have pain in different places all the time. One day it is in my right shoulder, the next day in my right wrist, and the following day in my left wrist. I’m stiff everywhere when I get up in the morning or if I sit for any length of time. And I feel so tired, like I have a case of the flu that won’t go away.” The patient is allergic to IV iron dextran from which she has developed shortness of breath. She rarely uses alcohol and does not smoke. She is taking an over-the-counter calcium supplement, levothyroxine sodium, and venlafaxine. There is no family history of rheumatoid arthritis. Physical Examination and Laboratory Tests The patient is pleasant and alert, but appears very tired. She is in moderate acute distress from joint pain. Vital Signs BP  125/80 left arm, sitting; P  80; RR  15; T  100.0°F; Ht  54; Wt  140 lbsHEENT • Head atraumatic • PERRLA • Normal funduscopic examination • EOMI • TMs intact Skin • Intact, warm, pink, and dry • No rashes • Normal turgor Neck • Supple with no jugular vein distention or thyromegaly • No bruits • Mild lymphadenopathy bilaterallyLungs • Clear to auscultation and percussion Heart • RRR • Normal S1, S2; no S3 or S4 • No murmurs, rubs, or gallops Abdomen • Soft, non-tender, and non-distended • Positive bowel sounds throughout • No superficial veins or organomegaly Breasts No lumps, dimpling, discharge, or discolorationGenitourinary • Last menstrual period 16 months ago • Normal pelvic exam and Pap smear Neurologic • Alert and oriented  3 • Cranial nerves II-XII intact • Muscle strength: 5/5 upper extremities, 4/5 lower extremities • DTRs 2 in biceps, triceps, and patella Rectal Heme-negative stoolMusculoskeletal, Extremities • No clubbing or ankle edema • Hands: Swelling of the 3rd, 4th, and 5th PIP joints bilaterally; pain in the 4th and 5th MCP joints bilaterally; poor grip strength bilaterally • Wrists: Good range of motion, fixed nodule at pressure point on left side • Elbows: Good range of motion, fixed nodule at pressure point on right side • Shoulders: Pain and decreased range of motion bilaterally • Hips: Good range of motion • Knees: Pain, significant edema, and decreased range of motion bilaterally • Feet: No edema, full plantar flexion and dorsiflexion and full pedal pulse bilaterally Laboratory Blood Test Results Na 140 meq/L ANA Negative Hct 43% Uric acid 2.9 mg/dL K 3.7 meq/L ESR 38 mm/hr WBC 15,100/mm3 Cholesterol 189 mg/dL Cl 104 meq/L Cr 1.0 mg/dL Plt 270,000/mm3 Albumin 4.0 g/dL HCO3  23 meq/L Glucose, fasting 94 mg/dL RBC 4.7 million/mm3 TSH 1.7 µU/mL BUN 18 mg/dL Hb 14.9 g/dL Ca2 8.8 mg/dL RF PositiveUrinalysis Normal with no RBC, WBC, or protein Bruyere Chest X-Ray No fluid, masses, infection, or cardiomegaly Hand X-Ray Soft tissue swelling and bone demineralization; no erosionsSynovial Fluid Analysis (Left Knee) • 7.4 mL volume • Cloudy and yellow in appearance • 14,000 WBC/mm3, primarily neutrophils • Glucose: 60 mg/dL s:  1. Which of the vital signs above is consistent with a diagnosis of rheumatoid arthritis and why?   2. List two conditions for which the drug venlafaxine is often prescribed.  3. Identify two abnormal findings from the physical exam above that are consistent with rheumatoid arthritis.  4. What is the association between the “fixed nodule(s) at pressure point(s)” on the left wrist/right elbow and a diagnosis of rheumatoid arthritis?   5. Why is it reasonable that this patient has no stiffness, pain, or swelling in the DIP joints of the fingers?6. Identify three abnormal laboratory tests that are consistent with a diagnosis of rheumatoid arthritis.   7. Why is it entirely appropriate that the PCP has ordered a TSH test for this patient?   8. Provide a reasonable explanation for the serum uric acid test result?  9. What is probably the first class of drugs that the PCP will prescribe for this patient?Health Science Science Nursing WGU D115

Let the Experts Do Your Homework Now



Do you have a similar question? Our professional writers have done a similar paper in past.
Give Us your instructions and wait for a professional assignment!

Get a plagiarism-free order today

we guarantee confidentiality and a professional paper and we will meet the deadline.

How it works

  • Paste your instructions in the instructions box. You can also attach an instructions file
  • Select the writer category, deadline, and education level and review the instructions
  • Make a payment for the order to be assigned to a writer
  • Download the paper after the writer uploads it

  • Will the writer plagiarize my essay?
    You will get a plagiarism-free paper and you can get an originality report upon request.

    Is this service safe?
    All personal information is confidential and we have 100% safe payment methods. We also guarantee good grades